의료보험 고액진료비 환자의 특성연구 = An Analysis on the Characteristics of High Cost Patients in the Regional Medical Insurance Program

다국어 초록 (Multilingual Abstract)

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over Per 6 months.
The study reveals that high cost users are those who have a longer length of stays(LOS), 40 days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the eiderly patients. They have Spent 814, 126won per day on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea.
Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Government should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

목차 (Table of Contents)

• Abstract = 1
• Ⅰ. 서론 = 2
• 1. 연구의 필요성 = 2
• 2. 연구의 목적 = 4
• Ⅱ. 연구방법 = 4
• 1. 자료 = 4
• 2. 연구방법 = 4
• Ⅲ. 연구결과 = 7
• 1. 고액진료비 환자의 특성 = 7
• 2. 각 고액진료비 환자군의 특성 = 14
• 3. 재입원 환자의 특성 = 23
• Ⅳ. 토의 = 27
• Ⅴ. 결론 = 29
• 참고문헌 = 30